Why Families in Maine Are Confused About Medicare — And Why It Matters for Long-Term Care
Every year, Medicare open enrollment arrives with a wave of advertising, mailers, phone calls, and plan comparisons. And every year, families walk into my consultations believing some version of the same idea:
“We’re choosing a Medicare plan so we can choose the right assisted living facility.”
Here’s the problem:
**Medicare has nothing to do with assisted living.
Nothing.**
The American health-care system has layered medical insurance on top of a long-term-care system that is fundamentally housing, not medicine. Families assume Medicare will help pay for care because it pays for so much else. But the policy reality is this:
Medicare = medical
MaineCare = long-term care
Assisted living = private-pay housing with support
Because these systems evolved separately, families end up making medical insurance decisions while standing in the middle of a housing crisis for older adults. This is not a personal failure. This is a systems failure.
And Maine, as the oldest state per capita, is experiencing the sharp edge of that failure first.
Why the confusion is so widespread
The structure itself causes it:
1. Medicare is federal and stable.
People hear “health insurance for older adults” and assume it includes care.
2. MaineCare is state-run and income-based.
Eligibility for long-term care is complex, slow, and unpredictable.
3. Assisted living is private.
Prices vary, staffing varies, and the medical system does not govern it.
We expect families to knit these systems together on their own — usually under stress, often in crisis.
Who helps families now? Two groups.
Private insurance agents
They are trained in:
Medicare Advantage vs Original Medicare
premiums, copays, networks
enrollment support
They are not trained in:
long-term care policy
MaineCare eligibility
assisted living operations
Their guidance is accurate — within the lane they work in.
Area Agencies on Aging (like SMAAA)
They provide:
neutral, no-commission Medicare counseling
explanations of the full system
support for people considering MaineCare
broader aging navigation
They do not choose plans for families or enroll them.
Why this distinction matters for policy
Families are being asked to make insurance decisions in the absence of context about care. This leads to:
delayed long-term-care planning
unpredictable facility placement
financial shocks
hospital-to-facility transitions that collapse
increased pressure on Maine’s already strained system
**Open enrollment is not just an insurance moment.
It’s a care-planning moment.**
We cannot keep treating it as paperwork.
Maine’s long-term-care crisis is accelerated every time families misunderstand what Medicare does — not because they failed to learn it, but because the system was built in a way that ensures they never would.
If we want real reform, we have to start with clarity.
The path forward
Explain the systems honestly.
Families deserve to know that Medicare does not cover assisted living.Connect Medicare decisions to care decisions.
Not because Medicare pays for care, but because misunderstandings delay planning.Strengthen the relationship between SMAAA, agents, and care navigators.
Each serves a different purpose. Families need the full picture.Prioritize early education.
The earlier people understand the difference between Medicare and MaineCare, the fewer crises they face.
Bottom line
Families aren’t confused because they’re unprepared.
They’re confused because the system is fragmented.
Maine is at the center of that fragmentation — and we have an opportunity to lead the country in clarity, transparency, and humane guidance.
